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There was a time in the not too distant past when the vast majority of doctors considered virtually all cases of impotence, or erection dysfunction, to be psychological in origin. In other words, men suffering from this very sensitive disorder were apt to be told that the problem was all in their minds.

Fortunately, the multifarious causes of impotence have been the subject of extensive study in the intervening years, and it is now widely recognized that most cases of ED are physical in nature, particularly among men who are 40 and over.

A Psychological Component

To be sure, there’s likely to be a psychological component to impotence even when the root cause of the problem is physiological. The more a man with ED fails to perform up to the standards he — and his partner — sets for himself, the more mental stress he feels, all of which tends to make the problem even worse.

However, among men in their 20s and 30s, a group generally considered to be at or near their sexual peak, a growing number of medical professionals believe the primary cause of ED can be traced to psychological problems.

Cause Is Often Psychogenic
Generally speaking, men in this younger demographic don’t report a particularly high incidence of impotence, but those who do often find that the cause is psychogenic.

Of impotence among men under 40, most cases “are a result of what is between the ears,” Pittsburgh urologist Jeffrey K. Cohen told Fox News. “It’s more a matter of perception of how they are functioning. They still want to be 16, and that’s just not possible.”

18 Million US Men Affected

A study conducted by researchers from the Johns Hopkins Bloomberg School of Public Health offers an excellent overview of the impotence problem in America, estimating that it affects more than 18 million men over the age of 20. However, only about 5 percent of those affected fall between the ages of 20 and 40, according to the study.

A major risk factor for ED among men of all ages is diabetes, which is the second-biggest cause of impotence among men under 40. Roughly 75 percent of all men with diabetes have ED, according to Virginia urologist Tony Sliwinski. However, as to the primary cause of impotence among those under 40, Sliwinski concurs with Cohen that it is psychological in nature.

Many Fail to Seek Help

Somewhat alarmingly, Sliwinski told Fox News, many young people who are suffering from ED, regardless of its cause, deny they have any problem at all and fail to seek professional counsel.

Temporary Fix for ED

According to Cohen, young men who believe they may be experiencing symptoms of ED “really need to talk to somebody — a urologist, psychologist. It’s a very difficult conversation to have with friends or your religious clergy. You can’t just say to anybody, ‘Hey, I’m having problems at home.’ ”

Psychological Factors

Although the psychological factors behind impotence among the young can take a wide array of forms, Cohen says that common reasons for young men’s inability to perform sexually are financial problems, illness of a child, death of a spouse or other family member, unrecognized homosexuality, and performance anxiety.

The fact that impotence of psychological origin is far less common than ED that can be traced to physical causes should in no way minimize the problem. In fact, men whose ED is psychological in origin are less likely to find their remedy in the impotence drugs that have helped millions of men to reclaim their sex lives.

Performance Anxiety

In an article on the website of The Good Men Project, psychologist Chris MacKinnon and psychotherapist Maneet Bhatia contend that performance anxiety is clearly one of the most common psychological causes of ED. They say that such concerns among men can lead to a vicious circle of anxiety in which the anticipated fear of not having an erection results in recurring difficulties in actually achieving one.

To break this cycle, men first need to recognize that it exists. All too often men set the bar too high by setting unrealistic goals. “Men need to reassure themselves that they do not have to be hard enough to drive nails every time they are intimate. Research has shown that many men with ED actually underrate their erectile response during sexual activity.”

Occasional Difficulty Is Normal

A second step toward overcoming performance anxiety, according to MacKinnon and Bhatia, is acceptance of the fact that occasional sexual difficulties are normal and thus so are the men who experience them. Needless to say, persistent inability to achieve and maintain an erection is indicative of a more serious underlying problem, but occasional problems need not be an immediate cause for concern.

Finally, men seeking to get beyond the bugaboo of performance anxiety should resist the trend toward instant gratification, which is so widespread in contemporary society. MacKinnon and Bhatia write: “This trend influences our relationships and sexual performance by creating a pressure to have an erection instantly and to be outstanding sexual performers.” This kind of thinking overlooks the fact that sexual performance is “a life-long learning process.” Looking at sexual performance as an evolving process can help to relieve the psychological pressure that is causing ED.

Evolution of Sexual Performance

MacKinnon and Bhatia compare the evolution of sexual performance to the ways in which basketball star Michael Jordan changed the basic character of his winning ways over the course of his career. In his early years, Jordan made a name for himself as a prolific dunker who dominated games with his athletic ability. As time went on and his physical abilities matured, he tended to rely more on jump shots as his winning strategy. “The results were the same. He was still able to score — he just did it differently.”

Men who suspect their impotence is psychological in origin can seek the counsel of a psychiatrist or psychologist who can help find a solution to their problem. Alternatively, men — and their partners — might want to visit a sex therapist. During the course of this type of treatment, the therapist works with the patient to discover the stress factors that are causing the problem. According to UrologyTeam.com, therapists often try to treat psychological ED naturally by using techniques designed to reduce the anxiety associated with intercourse. The affected patient’s partner can help with these techniques, which focus on the gradual development of intimacy and stimulation.

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